Future Sex: The Rise of Drug Resistant Gonorrhea

At the height of the 60s free love movement, it was a common misconception that STDs could be cleared up with a little penicillin. But, largely due to the AIDS crisis in the 80s, people have become more familiar with sexually-transmitted viruses that as of yet have no complete cure. Now cases of an antibiotic-resistant strain of gonorrhea are being reported around the world. How worried should we be?

This week the New Yorker has published an in-depth account of the rise of an antibiotic resistant strain on gonorrhea. According to the report, a prostitute arrived at a health clinic in Kyoto, Japan in 2009 for a routine checkup. She tested positive for gonorrhea, a very common STD, and was treated with a rigorous course of the antibiotic ceftriaxone. Yet, each time she returned to the clinic, her test remained positive. Initially, doctors thought she had been re-exposed, but later a more startling conclusion was reached: the strain of gonorrhea the woman had contracted was apparently resistant to ceftriaxone, the last line of antibiotic defense we currently have against the disease.

The superbug that appeared in Japan has also been detected twice in France and once in Spain, said P. Frederick Sparling, a professor of medicine at the University of North Carolina-Chapel Hill. Only one new antibiotic treatment for gonorrhea is currently in development.

The pharmaceutical development market is geared towards maintenance therapies: you will take Lexapro for years, if not indefinitely, for depression; you will take Lipitor for years to control your cholesterol. This means individual drugs will pay off for a lot longer, and so big pharmaceutical companies naturally invest more R&D money into longer-term therapies. This makes financial sense for them, but it leaves us with fewer new options when certain bacterial diseases develop resistance.

I was intrigued to read Steven Johnson’s short piece, “Inventors’ Gold,” in this month’s Wired magazine. He proposes a novel idea to correct for a pharmaceutical patent system that favors the development of long-term therapies. He suggests we “take a page from some of our deep-pocketed philanthropists, who have used competitions to rejuvenate space technology (the X Prizes), mathematics (the Millennium Prize), and more.” So perhaps what will work in creating new lines of antibiotic defense is a more open-source, lump-sum payout system, rather than working within the current drug patent system. In a lump-sum payout system, researchers would be awarded a large payment for their drug innovations, but no patent. This incentivizes the development of short-term therapies.

But back to the real world, where the incidence of drug resistant gonorrhea is rapidly rising. The disease is commonly thought to attack the genitals and reproductive organs, but it can also thrive in the pharynx at the back of the throat. From the New Yorker article: “With hairlike structures that extend from the cell surface, [gonorrhea] scavenges DNA that has been cast loose by the death or dissolution of other microbes, and incorporates them into its own genome.” This terrifying method of adaptation means that the bacterium is able to modify its genome easily and extensively, a unique way to develop antibiotic resistance. To put the biology here in context: The bacterium is not “trying” to develop antibiotic resistance; it is randomly altering its genome. However, any novel resistance that develops from these alterations will naturally be selected for, as the bacterium will survive treatment and possibly infect other humans.

The rise of resistant strains of gonorrhea likely coincides with our views on “safe sex.” Vaginal or anal sex is commonly through to be “safe” when condoms are used, but oral sex without protection is routine. Since gonorrhea is adept at living in the throat, it can easily be spread via oral sex on men. Oral sex performed on women is probably safe, as you’re not putting anything down your throat, and the saliva in your mouth will kill the bacteria.

The only way to prevent contracting drug-resistant gonorrhea, or any gonorrhea, during oral sex is to use a condom. Not a common practice, I know, but perhaps the conversation around this new superbug will help increase safe oral sex.